Lei�beiningar Rs�k-370 3.23.06 �tg. 9.0 �tg.dagur 10/21/2020

3.23.06 N�mispr�f � gersveppum

Tilgangur
Skilgreina hven�r n�mispr�f � gersveppum eru framkv�md og hva�a lyf eru notu�. Lei�beiningarnar gilda um n�mispr�f � Candida gersveppum, hvort sem �eir greinast � bakter�udeildum e�a sveppadeild S�klafr��ideildar. Fyrir gersveppi a�ra en Candida, sj� heimildir Arendrup et al, 2014, Espinel-Ingroff et al, 2012 og Perfect et al. 2010 � heimildalista.

�bendingar og bakgrunnur

�bendingar og bakgrunnur
�bendingar
N�mispr�f eru ger� � �llum dj�pum s�kingum og geta veri� hj�lpleg � ��rum s�kingum, sj� t�flu.
Bakgrunnur
Lyfjan�mi Candidaer breytilegt eftir tegundum, og einnig getur n�mi veri� mismunandi innan s�mu tegundar. �egar gersveppir r�ktast fr� l�ff�rum sem ekki eru �rverufr�, s.s. sl�mh��um og h��, �arf sjaldnast a� me�h�ndla sj�kling, �v� �eir eru hluti af e�lilegri l�kamsfl�ru. Dj�par s�kingar � bl��i og innri l�ff�rum �arf �� alltaf a� me�h�ndla, og raunverulegar sveppas�kingar � ��rum l�ff�rum eru l�ka venjulega me�h�ndla�ar. Lyf sem pr�fu� eru reglulega eru amphotericin B (AP), fluconazole (FL), voriconazole (VO) og anidulafungin (AND) e�a micafungin (MYC). Flucytosine (FC) og ketoconazole (KE) eru l�ti� sem ekkert notu� � me�fer� h�r � landi og �v� eru �au einungis pr�fu� samkv�mt s�rstakri bei�ni l�knis e�a s�klafr��ings.

A�fer� og val lyfja

A�fer� og val lyfja
A�fer�
Nota�ir eru Sensititre YeastOne YO10 bakkar fr� Thermo Scientific og pr�fin framkv�md skv. lei�beiningum. T�lkun � ni�urst��um er ger� � samr�mi vi� EUCAST sta�al, sj� n�mispr�f - sveppir - val og vi�mi�unarm�rk. Tafla 1 er lei�beinandi fyrir framkv�md n�mispr�fa og val lyfja � r�t�nuvinnu. � s�rst�kum tilfellum geta l�knar �kve�i� anna� en taflan tilgreinir. Vi� val � lyfjum var teki� tillit til marka�sleyfis fyrir vi�komandi s�kingar (�.e. lyf hefur leyfi fyrir �kve�nar s�kingar).

Tafla. N�mispr�f � gersveppum og lyf sem notu� eru hverju sinni (lyfjaval byggir � heimildum � heimildalista)

Tegund s�nis	N�mispr�f	Sveppalyf
Bl��	Alltaf	AP, FL, VO, AND/MYC^a
��aleggur	Alltaf	AP, FL, VO, AND/MYC^a
Innri l�ff�ri – �rverufr�, �.�.m. kvi�arhol, brj�sthol	Alltaf	AP, FL, VO, AND/MYC^a
�ndunarf�ras�ni	Ekki � r�t�nu. Skv. bei�ni l�knis	AP, FL, AND/MYC^a
�vag	Ekki � r�t�nu. Skv. bei�ni l�knis	AP, FL, AND/MYC^a,b
Munnhol og v�linda	Ekki � r�t�nu nema ef HIV s�ktir me� endurteknar s�kingar e�a endurteknar fluconazole me�fer�ir (�.e. ef fram kemur � bei�ni) Skv. bei�ni l�knis	AP, FL, IT Munnhol: m� b�ta vi� PC og AND/MYC^a ef FL og IT �n�mi e�a ekki kl�n�sk sv�run V�linda: b�ta vi� AND/MYC^a og VO
�armar	Nei
Skei� og sk�p, ytri kynf�ri karla	Ekki � r�t�nu. Skv. bei�ni l�knis	AP, FL, IT
H��	Alltaf ef vefjas�ni Annars ekki � r�t�nu. Skv. Bei�ni l�knis	AP, FL, IT
Eyru og augu	Alltaf ef s�ni �r mi�eyra e�a augnk�lunni (endophthalmitis) Annars skv. bei�ni l�knis	AP, FL, IT Endophthalmitis: b�ta vi� VO^c

Skammstafanir og ne�anm�lsathugasemdir:
AND: anidulafungin; MYC: micafungin; AP: amphotericin B; FL: fluconazole; IT: itraconazole; PC: posaconazole; VO: voriconazole.
^aAND/MYC: pr�fa micafungin ef C. albicans, C. glabrata e�a C. parapsilosis. Ef �nnur Candida tegund �� skal pr�fa b��i micafungin og anidulafungin;
^bEchinocandin skiljast ekki vel �t � �vagi en �� hefur veri� l�st �rangri � me�fer� �vagf�ras�kinga me� micafungin og caspofungin g�ti m�gulega gagnast vi� pyelonephritis.
^cVoriconazole er ekki marka�sett fyrir augns�kingar, en ��r ver�a oft �t fr� bl��s�kingu (marka�ssett fyrir bl��s�kingar) og a� auki kemst lyfi� inn� innra h�lf augans.

Heimildir

Jorgensen JH, Pfaller MA og f�l. Manual of Clinical Microbiology.
Amy L. Leber og f�l. Clinical Microbiology Procedures Handbook.
Arendrup MC et al. ESCMID^†and ECMM^‡joint clinical guidelines for the diagnosis and management of rare invasive yeast infections. Clin Microbiol Infect 2014; 20 (Suppl. 3): 76–98 (http://onlinelibrary.wiley.com/doi/10.1111/1469-0691.12360/pdf)
Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents. 2015. https://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf
Cornely OA et al. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: non-neutropenic adult patients. CMI, 18 (Suppl. 7), 19–37 (https://www.escmid.org/fileadmin/src/media/PDFs/4ESCMID_Library/2Medical_Guidelines/ESCMID_Guidelines/ESCMID_Candida_Guidelines_CMI_Dec2012_non-neutropenic_adult_patients.pdf)
Espinel-Ingroff A et al. Cryptococcus neoformans-Cryptococcus gattii species complex: an international study of wild-type susceptibility endpoint distributions and epidemiological cutoff values for fluconazole, itraconazole, posaconazole, and voriconazole. Antimicrob Agents Chemother. 2012 Nov;56(11):5898-906. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3486550/pdf/zac5898.pdf)
Espinel-Ingroff A et al. Cryptococcus neoformans-Cryptococcus gattii species complex: an international study of wild-type susceptibility endpoint distributions and epidemiological cutoff values for amphotericin B and flucytosine. Antimicrob Agents Chemother. 2012 Jun;56(6):3107-13. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3370763/pdf/zac3107.pdf)
Hope WW et al. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: prevention and management of invasive infections in neonates and children caused by Candida spp. CMI, 18 (Suppl. 7), 38–52 (https://www.escmid.org/fileadmin/src/media/PDFs/4ESCMID_Library/2Medical_Guidelines/ESCMID_Guidelines/ESCMID_Candida_Guidelines_CMI_Dec2012_neonates_and_children.pdf)
Ingibj�rg Hilmarsd�ttir. Naemisprof – abendingar sveppalyfja Des 2015 Naemisprof - abendingar sveppalyfja Des. 2015.docx
Lortholary O et al. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: patients with HIV infection or AIDS. ESCMID Fungal Infection Study Group. Clin Microbiol Infect. 2012 Dec;18 Suppl 7:68-77.
Pappas PG et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. CID 2016 (http://cid.oxfordjournals.org/content/early/2015/12/15/cid.civ933.full.pdf+html)
Perfect JR et al. Clinical Practice Guidelines for the Management of Cryptococcal Disease: 2010 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases 2010;50:291–322 . http://www.idsociety.org/uploadedFiles/IDSA/Guidelines-Patient_Care/PDF_Library/Cryptococcal.pdf
Schelenz S et al. British Society for Medical Mycology best practice recommendations for the diagnosis of serious fungal diseases. British Society for Medical Mycology. Lancet Infect Dis. 2015 Apr;15(4):461-74.
Ullmann AJ et al. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: adults with haematological malignancies and after haematopoietic stem cell transplantation (HCT). CMI, 18 (Suppl. 7), 53–67 (https://www.escmid.org/fileadmin/src/media/PDFs/4ESCMID_Library/2Medical_Guidelines/ESCMID_Guidelines/ESCMID_Candida_Guidelines_CMI_Dec2012_HCT.pdf)

3.23.06 N�mispr�f � gersveppum

Ritstj�rn

Sam�ykkjendur

�byrg�arma�ur

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